Assessment Flashcards

1
Q

Optimal Nutritional Status

A

Occurs when there are sufficient nutrients consumed to maintain day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness

“Persons having optimal nutritional status are more active, have fewer physical illnesses, and live longer than persons who are malnourished”

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2
Q

Vulnerable Groups and Malnutrition

A

Infants and children
Pregnant women
Recent immigrants
Persons with low incomes
Homeless persons
Hospitalized persons – increased length of stay, readmit rates, mortality
Aging adults
Frail elderly

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3
Q

Undernutrition

A

Occurs when nutritional reserves are depleted – when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands

Vulnerable groups are at risk for:
Impaired growth and development
Lowered resistance to infection and disease
Delayed wound healing
Longer hospital stays
Higher health care costs

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4
Q

Overnutrition

A

Overconsumption of calories, fat & salt; risk for obesity related diseases; DM, CVD

Increases risk for:
Heart disease and hypertension
Type II diabetes
Stroke
Gallbladder disease
Sleep apnea
Certain cancers
Osteoarthritis

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5
Q

Metabolic Syndrome (MetS)

KNOW THIS

A

Diagnosed in the presence of 3 out of 5 biomarkers – affects 35% of adults and 50% of people age 60 and older

Waist circumference
Gender-based measurements

Glucose level
Above 100 mg/dL or being treated for hyperglycemia

High-density lipoprotein (HDL-C) Gender-based measurements or being treated for hyperlipidemia

Triglyceride (TG) level
Above 150 mg/dL or being treated for elevated TG

Hypertension (HTN)
Systolic and diastolic parameters or being treated for HTN

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6
Q

Fast Facts:

A

Estimated 17% of children and adolescents, ages 2 to 19 are overweight or obese

66% of adults in United States are either overweight or obese.

For children, overweight defined as body mass index (BMI) equal to or greater than 95th percentile based on age- and gender-specific BMI charts

For adults
Overweight defined as BMI of 25 or greater
Obesity defined as BMI of 30

Being overweight during childhood and adolescence associated with increased risk for becoming overweight during adulthood

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7
Q

BMI Adults

A

BMI- body mass index
BMI= wt (in lbs.)/ht (in inches)2 x 703

<18.5 underweight
18.5-24.5 normal wt
25-29.9 overweight
30-39.9 obese
>40 extreme overweight

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8
Q

BMI Children

A

85th percentile - overweight
95th percentile- obesity

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9
Q

Development considerations

A

Time from birth to 4 months of age is most rapid period of growth in life cycle.

Infants – lose wt. during 1st week of life and then regain, double birth weight by 4 mos. & triple by one year.

Breastfeeding is recommended for full-term infants for first year of life because breast milk is ideally formulated to promote normal infant growth and development and natural immunity.

Breastfeeding may be helpful in avoiding overweight- avoid if mom HIV +

Brain size increases rapidly in early childhood; need for essential fatty acids for development.

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10
Q

Adolescence

A

Caloric & protein needs increase during adolescence- growth spurts and endocrine and hormonal changes

Caloric and protein requirements increase to meet this demand, and because of bone growth and increasing muscle mass (and, in girls, the onset of menarche), calcium and iron requirements also increase.

Calcium & iron esp. important in girls

Typical girl doubles wt between 8-14; boys between 10-17

Childhood is the most active period in the life span with levels of activity decreasing.

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11
Q

Childbearing

A

Pregnancy & Lactation
Increased need for calories and protein, vitamins, calcium, iron & other minerals

National Academy of Sciences (NAS) recommends weight gain of
25 to 35 lb for women of normal weight.
28 to 40 lb for underweight women.
11 to 20 lb for overweight women.

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12
Q

Developmental Considerations: Adulthood

A

Growth and nutrient needs stabilize

Lifestyle factors are a significant contributor to new-onset illness or exacerbation of chronic illness

This is the time to focus on patient education– on how to maintain optimal health (and prevent or delay onset of chronic disease)

Adult emergence of Metabolic syndrome is a concern leading to increased cardiac risk.

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13
Q

lifestyle factors

A

Smoking, ETOH (alcohol), coffee, lack of exercise, stressful lifestyle, high fat, high salt intake contribute to nutritional deficiencies.

Other considerations
Dental health
Malabsorption
Parasites
Food intolerances
GI diseases

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14
Q

Developmental Considerations: Aging Adult

A

Age-related changes place older adult at risk for undernutrition or overnutrition

Consider normal physiological changes in aging adults that directly affect nutritional status

Major risk factors include:
Poor physical or mental health
Social isolation
Alcoholism
Limited functional ability
Poverty
Polypharmacy

Physiologic changes of aging
General state of health
Socioeconomic conditions frequently have a significant effect on nutritional status
Decline of extended families and increased mobility of families reduce available support systems
Factors related to meal preparation:
Transportation to grocery stores
Physical limitations
Income
Social isolation
Polypharmacy- multiple medications

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15
Q

Cultural Considerations: Immigrants

A

Common nutrition-related problems of new immigrants from developing countries include:
General undernutrition
Hypertension
Diarrhea
Lactose intolerance
Osteomalacia (soft bones, vit D deficiency)
Scurvy (vit C deficiency
Dental caries

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16
Q

Cultural Competence and Religion

A

Knowing a person’s religious practices related to food enables you to suggest improvements or modifications that do not conflict with dietary laws
Kosher
Halal
Islam
Buddhist (vegetarian)
Hindu (vegetarian)

Fasting and other religious observations may limit a person’s food or liquid intake during specified times

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17
Q

Conditions (“allergies”) Affecting Food Options

A

Lactose intolerance
Lactase enzyme missing or in sufficient amount

Celiac disease
Gluten allergy
Wheat, rye, barley

Autoimmune issue where damage occurs to lining of small intestine

18
Q

Lactose Intolerance

A

Present in 30 - 50 million Americans

Up to 80% of African Americans

80% to 100% of Native Americans

90% to 100% of Asian Americans

Least common among people of northern European descent

19
Q

Nutritional Screening

A

24-hour recall

Food frequency questionnaire

Food diary

Direct observation of feeding with documentation

For the hospitalized patient, confirm nutritional intake with calorie counts
Consumed and/or infused (TPN)
Expect to monitor I & O

Dietary history and clinical information
Weight and weight history

Physical examination (PE) for clinical signs
Anthropometric measures
Laboratory tests

20
Q

Subjective Data: Family History

A

Heart disease
Osteoporosis
Cancer
Gout
Gastrointestinal disorders
Obesity
Diabetes

21
Q

Cachectic

A

fat and muscle wasting

22
Q

Edematous

A

swollen-extra fluid

23
Q

Android obesity

A

Apple Shape

Waist-to-Hip Ratios
Ratio ♂ > 1.0
Ratio ♀ > .8

24
Q

Gynoid obesity

A

pear shape

25
Q

Anthropomorphic Measures

A

Height
Weight
Triceps skinfold thickness
Waist-to-hip ratio

waist circumference/hip circumference
>1.0 in men
>.8 in women
Indicates high concentration of visceral fat; increased risk for DM,CAD

BMI

26
Q

Triceps skinfold (TSF)

A

Standards and techniques are most developed for this site
10% difference from standard suggests under- or over-nutritional state

Mid-arm circumference (MAC)
Estimates skeletal muscle mass and fat stores

27
Q

Petechiae

A

Dry/flaky/scaling?

28
Q

Marasmus

A

protein-calorie malnutrition – looks starved

29
Q

Kwashiorkor

A

protein malnutrition
– may appear well

30
Q

Pellagra

A

Niacin deficiency – pigmented scaling lesions

31
Q

Scorbutic gums

A

Vitamin C deficiency

32
Q

Follicular hyperkeratosis

A

Vitamin A and/or linoleic acid deficiency, dry bumpy skin

33
Q

Bitot’s spots

A

Vitamin A deficiency – foamy plaques in cornea

34
Q

Rickets

A

Vitamin D and calcium deficiency

35
Q

Magenta tongue

A

Riboflavin deficiency – beefy red in appearance

36
Q

Height issues

A

Arm span, which correlates with height, may be better measurement for elderly

37
Q

Best indicators of nutritional status

A

Glucose

Hemoglobin

Transferrin

Normal hemoglobin level for African Americans is one gram lower than levels for other groups
Data indicate that Native Americans, Hispanics, Asian-Americans, and whites do not differ in this factor

Cholesterol & triglycerides

Serum albumin & total protein

38
Q

Long term weight loss

A

Regular physical exercise
4 to 5 times a week for 30 minutes

Eating a low calorie, low fat diet
Caloric intake 1400 to 1500 kcal/day
Fat intake 20% to 25% of total calories

Monitoring daily food intake
Food diary
Portion size
Weight

39
Q

Nutritional Consequences of Bariatric Surgery

A

Potential nutritional consequences and related dietary change as a result of surgical intervention.

Malabsorption of protein and calories
-Eat small nutrient dense meals.

Malabsorption of vitamins and minerals
-Taking supplements

Weight regain
-Avoid excess intake of calorically dense/liquid foods.

Obstruction
-Avoid chunks of food that could cause blockage.

40
Q

Serial assessment

A

Used to monitor nutritional status in malnourished individuals or in individuals at risk for malnutrition

Evaluate weight and dietary intake weekly in patients who are under-nourished
Because other nutritional assessment indicators may be collected biweekly or monthly